http://circ.ahajournals.org/content/127/2/260AHA Scientific StatementApproaches to the Prevention and Management of Childhood Obesity: The Role of Social Networks and the Use of Social Media and Related Electronic Technologies A Scientific Statement From the American Heart AssociationJennifer S. Li, MD, MHS, Chair; Tracie A. Barnett, PhD; Elizabeth Goodman, MD; Richard C. Wasserman, MD; Alex R. Kemper, MD; on behalf of the American Heart Association Atherosclerosis, Hypertension and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity and Metabolism

Several Internet-based randomized trials have been performed in overweight children and adolescents. An et al54 performed a systematic review of studies published in peer-reviewed journals that used randomized, controlled trials via the Internet and reported weight loss, BMI change, physical activity, and dietary intake as outcome variables. Studies were included only if the Internet intervention was directed toward study participants or their families, not solely toward healthcare providers. Eight studies were included. Studies were variable in their use of social media as the main agent of therapy or as an adjunct to other types of therapy, including nutrition and physical activity engagement. Six of these studies suffered from small sample size (n=35–80),56–60 and 3 studies were from the same cohort of patients.58,59,61 Doyle et al57 and Celio et al56 demonstrated a reduction in BMI z scores in those receiving an interactive Internet-delivered cognitive behavioral program compared with those receiving usual care with basic information provided on nutrition and physical activity. Baranowski et al,60 however, did not show any significant difference in girls randomized to a monthly Internet intervention and those receiving no Internet intervention; however, both groups also attended a special 4-week summer day camp, and there was a significant difference in the baseline mean BMI between the Internet intervention group (21.1±4.4 kg/m2) and the control group (26.3±7.9 kg/m2). White et al61 and Williamson et al58,59 studied the same cohort, demonstrating that active family-based behavioral Internet interventions resulted in more loss of body weight and lower dietary fat intake than passive primary health education. The Internet-based interactive program included e-mail counseling on self-monitoring, problem solving, goal setting, and relapse prevention. Compared with a noninteractive program, greater efficacy was seen in the interactive program. In 2 larger studies, Marks et al62 studied 359 adolescent girls and did not demonstrate any significant difference between subjects receiving intervention over the Internet and those receiving a print workbook, with both groups improving in the degree of physical activity, self-efficacy, and intentions. Haerens et al63 studied 2991 seventh and eighth graders, randomizing them to receive a computerized, tailored intervention either with or without parental involvement or to a control group with no intervention. In girls, the 1- and 2-year differences in BMI and BMI z score in the intervention with parents group were significant. There was a significant sex interaction with no positive intervention effect seen in boys. Recently, a school-based, randomized, controlled trial in rural Louisiana was implemented within 14 schools using a student Web site, an Internet counselor Web site, and an Internet counseling process. The Internet intervention contained lessons on health eating and regular physical activity, and students communicated with a counselor through a chat room and e-mail.64 This study was focused on the prevention of weight gain. In summary, findings from these studies have been mixed, with some finding improvement.56–58,61 Interpreting the effectiveness of these interventions and the role of social networks is challenging because of the small sample sizes, the variations in treatment provided to the intervention and control groups, the outcome measures, and the duration of follow-up. Furthermore, there was variable use of the Internet-based interventions, raising questions about the degree to which the interventions led to meaningful virtual social networks. Two other larger trials had similar limitations and had mixed results.62,63 Although some of these studies focused on the prevention of abnormal weight gain and the treatment of overweight and obesity, studies also need to be performed on the maintenance of appropriate weight once weight loss is achieved. Of note, attrition rates affect the overall power of the studies. Log-on rates, which are measures of program use, are highly variable. E-mail reminders, financial incentives, and the provision of a Web master to help participants with technical difficulties can have positive effects on the log-on rate.65

Transcript

1.
The Use of Social Media Technologies on
Management of the National and
Regional Obesity Crisis
Clinical Science Background:
Daniel A. Terreros MD, PhD
Social Systems Technologies:
Holly E. Russo, RN, MSN, MSECS

2.
Lecture Aims
• Why obesity is now considered a disease and which are its
molecular causes!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need to
continue to explore; the future!

7.
 Obesity is a state of inflammation
 Cytokines TNF alpha, and IL6 are elevated in obesity and cause genetic programing to Type 2 diabetes
 Malnutrition is a state of inflammation
 Cytokine IL-6 is elevated in malnutrition and causes genetic programing to type 2 diabetes
The El Paso Epigenetic Nutritional Hypothesis:
“Both Malnutrition and Obesity at Certain Stages of Pregnancy
and through Inflammatory Cytokines Programs the Fetus for a
more Efficient Utilization and Storage of Energy”
D.A. Terreros
The Borderland Paradox

10.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need to
continue to explore; the future!

11.
Social Media in Healthcare
• The term social media refers to the use of Web-based and
mobile technologies that are commonly used for interaction
and communication within networks.
• Research underscores strong associations between
participation in social networks and preventive health
behavior.
• Alters may provide emotional support, instrumental support
(financial or practical), informational support, or appraisal
(decision-making) support.

12.
Digital Social Integration and Capital
• Social integration, can increase access to health
information and promote self-worth and self-care
on the basis of societal norms and expectations.
• Social capital has been defined as the resources
obtained by a group or an individual through a
network of social relationships, as well as the
number and quality of the relationships in the
network.

13.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and
more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need
to continue to explore; the future!

14.
Obesity and Social Media
• An analysis of the Framingham Heart Study,
which included only adults, found that spouses,
siblings, and friends were at greater risk for
obesity if their alters were obese.
• Among children and adolescents, body mass
index (BMI) is associated with school-based
friendship clusters; school friends are significantly
similar in terms of their BMI, with friends of the
highest BMI appearing to be most similar.

15.
Digital Integration of Obesity
Population Control
• Internet-based programs and other electronic
technologies have been used in both the
treatment and prevention of overweight and
obesity in youth.
• Benefits from these interactive electronic
interventions include their widespread availability
in the school and home, popularity among youth,
ability to engage and immerse participants, and
ability to provide immediate tailored feedback.

16.
Obesity Digital in Community
Integrative Programs
• Obesity-related health behaviors are also associated with adolescent social
networks, including participation in organized sports, fast food consumption, and
computer/video game screen time.
• Social networks therefore may be critical in shaping young people’s eating
behaviors and body weight and vice versa, and their role suggests the potential of
social network–based health promotion interventions.
• Combining social network analysis with environmental assessment can identify
interventions for childhood obesity treatment or prevention.
• Geocaching, an activity during which individuals or groups search for items
described on Web sites using navigational tools, such as GPS tracking devices, also
leverages social networks and the built environment to increase physical activity
• In addition to targeting existing social networks, future interventions could be
based on the development of social networks purposefully developed to address
obesity.

17.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and
more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need
to continue to explore; the future!

18.
Adult Statistics
• 59% of U.S. Adults have looked online for health
information.
• 60% of U.S. adults say they track their weight, diet, or
exercise online.
• 85% of U.S. adults own a cell phone. Of those, 53%
own smartphones.
• One in three cell phone owners (31%) have used their
phone to look for health information.
Source: Fox, S & Duggan M. Mobile Health 2012. Pew Internet and Life Project .
Published November 8, 2012
Trends in Adulth Ownership of Media

19.
Trends in Teens Ownership of Media
• 78% of teens now have a cell phone, and almost
half (47%) of those own smartphones.
• One in four teens (23%) have a tablet computer, a
level comparable to the general adult population.
• Nine in ten (93%) teens have a computer or have
access to one at home
Source: Madden, M., Lenhart,A., Duggan M.,Cortesi, S., and Gasser, U. Teens and Technology 2013. March 13, 2013. Pew Research Center
and Berkman Center for Internet and Society at Harvard University

20.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Trackers of Health Data
• Use of apps in tracking food consumption, exercise and more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need to
continue to explore; the future!

21.
Who is Tracking Health Data
• The Pew Internet survey shows that people living with one or more chronic
conditions are no more likely than other U.S. adults to track their weight, diet, or
exercise routine.
• Nearly half (45%) of U.S. adults are dealing with at least one chronic condition.
• In the general population, women and men are equally likely to report tracking
their weight, diet, or exercise routine.
• Non-Hispanic whites and African Americans are more likely than Latinos to track
these basic health indicators: 62%, 59%, and 51% of each group respectively do so.
• Sixty-eight percent of college graduates track their weight, diet, or exercise
routine, compared with 54% of adults with a high school diploma and 43% of
those who have not graduated from high school.

22.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Trackers of Health Data
• Use of apps in tracking food consumption, exercise and
more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need to
continue to explore; the future!

23.
Use of Apps in Obesity
• Lubans et al. provided adolescents with an intervention
incorporating pedometers and e-mail support on
physical activity, sedentary behavior, and healthy
eating.
• Among those in the intervention group, boys increased
their step counts by 956±4107 steps per day and girls
by 999±1999 steps per day. The intervention
significantly decreased the number of energy-
dense/low-nutrient snacks consumed by boys
(P=0.043) and increased the amount of fruit consumed
by girls (P=0.028). The intervention did not have a
statistically significant effect on sedentary behavior.

24.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and
more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need
to continue to explore; the future!

25.
Combining Social Networks
• One in five trackers in the general population (21%) say
they use some form of technology to track their health
data, which matches our 2010 finding.
• Specifically:
– 8% of trackers use a medical device, like a glucose meter
– 7% use an app or other tool on their mobile phone or
device
– 5% use a spreadsheet
– 1% use a website or other online tool

26.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and
more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need
to continue to explore; the future!

27.
Interactive Game Engagement
• Active video games enjoy widespread appeal to
youth and have been demonstrated to increase
energy expenditure and physical activity
compared with sedentary video gaming.
• Several of these technologies also offer Internet
connectivity, including Nintendo Wii Fit and
Microsoft Kinect, and the ability to join an online
gaming service that allows one to play games
against other members in its online community
with the use of an avatar.

28.
Lecture Aims
• Why obesity is now considered a disease!
• Understand Social Media in Health Care!
• Social Media has a place in Obesity Management!
• Trends in ownership and use of smartphones, tablets,
computers!
• Use of apps in tracking food consumption, exercise and
more!
• Combining social networks with other applications!
• Interactive Gaming Engagement!
• What has been studied thus far and where do we need
to continue to explore; the future!

33.
• This iOS-only app has you
complete a test workout, in
which you rate different
exercises as easy, tough,
impossible, or "need to learn,"
which then informs the app
going forward how difficult
your workouts should be.
• Georges St-Pierre uses the
principles of gymnastics,
bodyweight exercises and High
Intensity Interval Training
• You can choose workouts of 20,
40, or 60 minutes
http://gspofficial.com/touchfit
Obesity Apps Studied Thus Far – Touchfit GSP

34.
• Designed for
counting calories and
logging exercise, can
help you lose weight,
especially if you tend
to eat name-brand
American foods.
• Available on:
Android, iOS, Kindle,
Nook, and Web.
Obesity Apps Studied Thus Far- Lose it

36.
Obesity Apps Studied Thus Far- Counteat.calories
• Helps you estimate,
rather than count,
how many calories
you consume at
each meal
• Helps you find a
range, rather than a
precise target, for
how much you
should eat.
• Available on: iOS

37.
Obesity Apps Studied Thus Far- Endomondo Sports Tracker
• Members use GPS
features to track how
much they run, cycle,
jog, and so forth, and
share their progress
with others.
• Languages: English,
Spanish, others
• Available on:
Android, BlackBerry,
iOS, Windows Phone,
and Web

38.
Obesity Apps Studied Thus Far- The Eatery
• Use The Eatery to
snap photos of your
food. We’ll give you
something much
more helpful than
calorie counts.
• Invite friends to
follow and support
you.
• Get insight into your
eating habits.
• Available on: iOs

39.
Obesity Apps Studied Thus Far- Fitbit.com
• If you do own one of the
Fitbit gadgets, you can
sync it so that the data
it collects automatically
appears on your
account.
• On its own, the Fitbit
site gives you the ability
to record your personal
data to keep track of
your fitness goals.
• Available on: Android,
iOS, and Web.

40.
Obesity Apps Studied Thus Far- Fitocracy
• Uses game-like stats
to spur on friendly
competition and
increase your
dedication to working
out.
• You post what you did
or did not do much
like Facebook.
• Available on:
Android, iOS, and
Web.

41.
Obesity Apps Studied Thus Far- Fitsby
• You and your
friends decide how
much money you
want to wager, and
the person who
checks into the gym
the most in a given
period of time wins
the pot.
• Available on:
Android

42.
Obesity Apps Studied Thus Far- Gain Fitness
• Workout coaching
app and website.
• AIN Fitness runs as
you actually work out.
• You listen to or read
its instructions and it
helps you keep track
of repetitions and
even includes a timer
when appropriate
• Available on: iOS and
Web.

43.
Obesity Apps Studied Thus Far- Map MyFitness
• Map My Fitness will give you
the widest range of
supported activities
• Let’s you track different
sports and workouts.
• uses GPS to track the routes
you travel, and shows you a
map of the ground you
covered when you're done.
It also displays length, in
both time and distance, as
well as pace, maximum
speed, and a few other
statistics.
• Available on: Android, iOS,
Windows Phone